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Charles E. Irwin, M.D., '69: Keen on teens
Dr. Charles Irwin didn't think he'd be promoted. It was 1984, and Irwin had spent the previous decade building the division of adolescent medicine at the University of California at San Francisco (UCSF), first as a fellow and then as an assistant professor of pediatrics. In many ways, Irwin was a model academician: he worked grueling hours; he successfully juggled the roles of teacher, clinician, and researcher; and, in 1977, he had secured a $2.5-million grant to establish an adolescent-medicine training program at UCSF. The problem was that he wasn't doing the kind of basic-science, wet-lab research that most academic physicians did at the time.
"I'm not sure we want this kind of research done in a department of pediatrics," Irwin recalls members of the department saying. The design of Irwin's studies drew as much from the social sciences as from the clinical sciences. It also didn't help that he studied then-taboo subjects like sexually transmitted diseases and that adolescent medicine was still an emerging field.
Irwin and his colleagues were publishing papers in reputable journals, such as Annals of Internal Medicine and Pediatrics, but they had titles like "Appointment-keeping behavior of adolescents"; "Emerging patterns of tampon use in the adolescent female: The impact of toxic shock syndrome"; "The adolescent ballet dancer: Nutritional practices and characteristics associated with anorexia nervosa"; and "Chlamydia trachomatis: Important relationships to race, contraceptive use, lower genital tract infection and Papanicolaou smears."
Discouraged, and worried that academic medicine was not for him, Irwin phoned his favorite mentor, Dr. Carleton Chapman, who had been dean of Dartmouth Medical School from 1966 to 1973. The two had become close when Irwin was a medical student in the late 1960s. "As many of us were being radicalized by the Vietnam War, he was a voice of reason," Irwin says of Chapman, who chatted with students and even invited them to dinner. The dean also cautioned students about attending certain meetings or risking arrest at protests. "You don't ever want to undermine the importance of or how you can use your M.D. to be a good advocate for change," Irwin recalls Chapman saying. At the time, Irwin adds, "it was
pretty unusual for medical students to have a relationship with or be heard by a dean."
As he had done when Irwin was a student, Chapman offered the young alumnus encouragement, as well as practical advice on preparing for the promotions committee's review. "Walk proud. Stand high," Chapman urged. "Don't let them push you around."
Irwin took the advice to heart. Evaluations should be based on science not personal opinion, he argued. Following Chapman's counsel paid off—Irwin was promoted, and eventually, under his leadership, the division of adolescent medicine became a powerhouse at UCSF. He is now a professor and vice chair of UCSF's Department of Pediatrics and director of its Division of Adolescent Medicine.
"For many years, we were on the margin here," says Irwin. Today, one could say Irwin and his colleagues set the margins. Adolescent medicine, one of 15 divisions within the Department of Pediatrics, accounts for at least a third of the department's grant funding. The division
also houses two federally funded centers, both headed by Irwin: the National Adolescent Health Information Center and the Policy Center for Middle Childhood, Adolescent, and Young Adult Health. The centers provide policy-makers with information about access to care, insurance programs, and health initiatives for adolescents. UCSF's adolescent medicine training program, also led by Irwin, has turned out about 150 physicians and researchers. "When I think about what my legacy will be, it is the people that I've trained," says Irwin, whose trainees include leaders in adolescent medicine at Georgetown, Johns Hopkins, the University of California at Los Angeles, the University of North Carolina at Chapel Hill, the University of Wisconsin, and Yale.
Irwin is active on the national level, too. In the 1980s, he led the initiative to establish subspecialty certification in adolescent medicine; in 1998, he received the American Academy of Pediatrics' lifetime achievement award in adolescent medicine; from 2002 to 2003, he served as president of the Society for Adolescent Medicine; and in 2004, he became the
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Jennifer Durgin is the senior writer for Dartmouth Medicine magazine.